New Study Shows Lung Cancer Surveillance in the United States Misses Most Patients; Northwestern Medicine Researchers Urge Universal Age-Based Screening

In a new study of nearly 1,000 consecutive patients treated for lung cancer at Northwestern Medicine, researchers discovered only 35% would have qualified for screening according to the U.S. Preventive Services Task Force (USPSTF) screening criteria. The two-thirds of patients who would have been excluded were disproportionately women and never-smokers. Currently, USPSTF recommends annual lung cancer screenings for adults ages 50-80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years – a narrow window that excludes many vulnerable individuals.

In the new study, published on November 21 in JAMA Network Open, Northwestern Medicine researchers recommend expanding the universal age-based screening to 40-85. They estimate this would detect 94% of lung cancers, preventing more than 26,000 extra deaths annually. The research also demonstrates that such screening would be remarkably cost-effective, with the minimal risks from radiation exposure or biopsies far outweighed by the potential to save lives.

“We moved to universal age-based screening for breast and colon cancer with tremendous success, and we need to move to the same approach for lung cancer. Chest screening offers something unique – with one low-dose scan, we can assess lungs, heart and bones comprehensively. This baseline scan becomes invaluable for monitoring their health over time,” said Ankit Bharat, MD, chief of thoracic surgery and executive director of the Northwestern Medicine Canning Thoracic Institute.

Lung cancer remains America’s deadliest cancer, claiming more lives than breast, colon and prostate cancers combined, accounting for one in every five cancer deaths among both men and women. The disease is particularly insidious: nearly 80% of cases aren’t discovered until they’ve reached advanced stages, largely because symptoms rarely appear until it’s too late. The widespread misconception that only smokers develop lung cancer, combined with limited screening access for those without tobacco history, contributes to these devastating statistics. Researchers at the Canning Thoracic Institute predict that a universal age-based screening (40-85) could enhance detection, improve cost-effectiveness and address health inequities.

Providing low-dose CT screening to all eligible adults

In response to these findings, Northwestern Medicine has launched the Lung Health Center at the Canning Thoracic Institute to detect lung, heart and bone conditions earlier. The center, supported by a generous gift from John and Rita Canning, will encourage lung cancer screening for Northwestern Medicine patients and conduct studies to evaluate low-dose CT screening with necessary assessments in patients who might not qualify for lung cancer screening. In addition, scans from all patients will be evaluated for their ability to detect early pulmonary fibrosis, post- COVID lung damage, cardiovascular disease, osteoporosis and other conditions affecting millions of Americans. The results of these screenings will be studied and published to inform changes to existing guidelines.

The scan that takes less than 10 seconds and doesn’t need any intravenous dyes provides a complete picture of the chest cavity, creating a baseline image patients can keep for life. This approach also addresses critical gaps in preventive care, particularly for the growing number of patients experiencing lasting respiratory effects from COVID-19 and other environmental exposures.

"Nearly six years after the pandemic's start, we're seeing increasing numbers of patients with lung scarring and fibrosis from COVID-19, especially those who get reinfected with respiratory viruses," said Dr. Bharat. “The damage compounds with each infection. Early detection through comprehensive screening can help us intervene before these conditions progress to requiring transplantation.”

Health concerns beyond the lungs

The Lung Health Center addresses multiple health concerns simultaneously. Beyond respiratory conditions, the screening can detect coronary calcium deposits that indicate cardiovascular risk and can identify early signs of osteoporosis, which is particularly important for women's health. Currently, cardiovascular disease remains the leading cause of non-cancer deaths nationally, while lung disease, including cancer, represents the top cancer-related mortality for both men and women.

"This initiative transforms how we approach chest health comprehensively," said Momen Wahidi, MD, interventional pulmonologist and medical director of the Canning Thoracic Institute. "Instead of waiting for symptoms to appear, we're giving patients and physicians a complete picture of chest health that can guide preventive care across multiple specialties."

The center particularly encourages screening for individuals who may have sustained lung damage from various sources:

· COVID-19 survivors experiencing ongoing respiratory issues

· People exposed to wildfire smoke, industrial pollution, or high radon levels

· Individuals with family history of lung disease or pulmonary fibrosis

· Those exposed to secondhand smoke, vaping, or marijuana use

· Asian women and other demographics at elevated risk for lung conditions

· Anyone seeking baseline chest health assessment

“We're seeing younger patients with respiratory problems from vaping, environmental exposures, and COVID-19 who would never qualify for traditional screening,” said Scott Budinger, MD, chief of pulmonary and critical care at the Canning Thoracic Institute. “This lung screening approach allows us to catch interstitial lung disease, pulmonary fibrosis, lung cancer, and other conditions years before they'd typically be diagnosed.”

Young mothers diagnosed with lung cancer

Danielle Hoeg

Danielle Hoeg, a 45-year-old mother of three from Chicago, knows the importance of comprehensive screenings. In March 2023, Hoeg had finished breastfeeding her son and felt like something was “off” in her body. She scheduled appointments for a mammogram, colonoscopy, skin check and bloodwork, but everything came back normal – still, Hoeg couldn’t help but feel like something was wrong.

In March 2024, Hoeg underwent a full body MRI scan and the findings revealed something was happening on her lung. She was urged to see Dr. Bharat who ordered a CT and PET scan and the results came back showing the spot on Hoeg’s lung was 99.9% cancerous. Hoeg was in disbelief as she had never smoked and was in picture perfect health. Soon after, she underwent a minimally invasive lung conserving surgery at Northwestern Memorial Hospital where Dr. Bharat removed the spot on her lung and confirmed the non-smoker had an aggressive stage 1 lung cancer. Today, Hoeg is cancer-free but still carries the experience with her.

“Every young person I see, I immediately think, ‘do they have lung cancer? How do I convince them to get checked out?’” said Hoeg. “With more women, never-smokers and young people being diagnosed with lung cancer, I’m a huge advocate for the Lung Health Center and encourage adults to get screened.”

Carla Tapia

Carla Tapia, a mother of three from Beltsville, Md., was shocked to learn about her stage 4 lung cancer diagnosis at the age of 33. Tapia had some smoking exposure during her teenage years but quit when she was 18 and currently doesn’t meet the USPSTF screening criteria for lung cancer.

In December 2019, Tapia developed a fever and was diagnosed with pneumonia. Her symptoms progressed to a bad cough with mucus, but as the COVID pandemic hit, Tapia remained focused on her three kids and put her own health on the backburner.

By July 2020, she could no longer catch her breath and that’s when she was diagnosed with stage 4 lung cancer, which had spread to both lungs and was inoperable. For the next four years, Tapia underwent chemotherapy treatments, but the cancer kept growing. Out of options, she heard about the DREAM Program at Northwestern Medicine, which provides double-lung transplants to select patients with advanced lung cancers.

By the summer of 2024, Tapia’s health was quickly declining, and she flew to Chicago on supplemental oxygen for a transplant evaluation. On September 12, 2024, Tapia received a life-saving double-lung transplant at Northwestern Memorial, and the 38-year-old is now back home in Maryland.

“When I was diagnosed with stage 4 lung cancer, I was told there was no cure, but thanks to Northwestern Medicine, I’m alive today and no longer having to go to the hospital for weekly chemotherapy treatments. Instead, I just finished by bachelor’s degree and am hoping to go to law school,” said Tapia. “I keep hearing stories about young people being diagnosed with lung cancer, and if we could expand the screening guidelines, I believe more lung cancers could be caught at earlier stages, and more lives would be saved.”

By the summer of 2024, Tapia’s health was quickly declining, and she flew to Chicago on supplemental oxygen for a transplant evaluation. On September 12, 2024, Tapia received a life-saving double-lung transplant at Northwestern Memorial, and the 38-year-old is now back home in Maryland.

“When I was diagnosed with stage 4 lung cancer, I was told there was no cure, but thanks to Northwestern Medicine, I’m alive today and no longer having to go to the hospital for weekly chemotherapy treatments. Instead, I just finished by bachelor’s degree and am hoping to go to law school,” said Tapia. “I keep hearing stories about young people being diagnosed with lung cancer, and if we could expand the screening guidelines, I believe more lung cancers could be caught at earlier stages, and more lives would be saved.”

To schedule an appointment

Patients can access the Lung Health Center through a simple process beginning with a phone consultation. Marisol Munoz, nurse practitioner for the program, guides patients through each step.

“We make this as seamless as possible for patients,” said Munoz. “From the initial call through receiving results in 24-48 hours, our team coordinates everything. We work with insurance when covered and ensure eligible patients have access regardless of coverage through the Canning's philanthropic support.”

The Lung Health Center also includes a research component where participants contribute de-identified data to help establish new screening guidelines. The center incorporates artificial intelligence to provide rapid, highly sensitive analysis of results, with the goal of delivering comprehensive health insights within seconds of scanning.

The Lung Health Center has already launched at Northwestern Medicine McHenry Hospital and is expanding systemwide by the end of the year. Anyone over the age of 21 is eligible, with particular emphasis on those over 40 or with risk factors.

For more information or to schedule a screening consultation, call 312.695.1800 and mention the Lung Health Center, or email lunghealthcenter@nm.org.

The pulmonology and lung surgery program at Northwestern Memorial Hospital is proud to be the highest-ranked in Illinois for 14 straight years and No. 7 in the U.S. For more information, visit nm.org/pulmonary.